Does acute kidney injury alerting improve patient outcomes?

Abstract

Background Electronic alerts (e-alerts) for Acute Kidney Injury (AKI) have been implemented into a variety of different Electronic Health Records (EHR) systems worldwide in order to improve recognition and encourage early appropriate management of AKI. We were interested in the impact on patient safety, specialist referral and clinical management. Methods All patients admitted to our institution with AKI were included in the study. We studied AKI progression, dialysis dependency, length of hospital stay, emergency readmission, ICU readmission, and death, before and after the introduction of electronic alerts. The impact on prescription of high risk drugs, fluid administration, and referral to renal services was also analysed. Results After the introduction of the e-alert, progression to higher AKI stage, emergency readmission to hospital and death during admission were significantly reduced. More prescriptions were stopped for drugs that adversely affect renal function in AKI and there was a significant increase in the ICU admissions and in the number of patients having dialysis, especially in earlier stages. Longer term mortality, renal referrals, and fluid alteration did not change significantly after the AKI e-alert introduction. Conclusions AKI e-alerts can improve clinical outcomes in hospitalised patients.

Pediatric AKI in the real world: changing outcomes through education and advocacy—a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference

“…Educational interventions at teaching hospitals in the UK, designed to increase understanding of AKI, demonstrated increased physician awareness based on self-reported management of patients and comparison of AKI knowledge assessed on pre- and post-education questionnaires [ 12 ]. In another UK study, electronic alerts deployed at a teaching hospital not only raised awareness of AKI but improved outcomes, leading to less progression to higher stages of AKI, fewer emergency re-admissions, and a reduction in mortality [ 13 ]. A pediatric multi-center intervention to raise awareness of the impact of nephrotoxic medications on the development of AKI led to decreased AKI rates [ 14 ].…”

Electronic alerts in acute kidney injury: why does evidence of benefit remain elusive?

“…Interestingly, the development of AKI was similar in those categorized as low versus medium/high risk based on TIMP2ÃIGFBP7 levels (30.4 and 32.9%). There have been other recent reports of single-centre implementation of eAlerts [19], although the level of evidence generated from before-after comparisons (that cannot eliminate temporal trends that occur independently to the intervention) is less robust that that derived from randomised trials.…”

Care Bundle for Acute Kidney Injury in Cardiac Patients: A Cluster-Randomized Trial

“…Electronic alerts in the hospitals were recommended to improve the recognition of AKI, and an AKI electronic alert system was mandated by NHS England in all Laboratory Information Management Systems across the NHS in 2015 [5]. Several trials focusing on patient safety, specialist referral, and clinical management showed positive effects of AKI electronic alert systems, including more frequent medication-related recommendations per patient, a reduced progression to higher AKI stage, emergency readmission to hospital, reduced length of stay in hospital and death during admission [6][7][8], see Appendix A, Table A1. A pragmatic stepped wedge cluster randomized trial showed improved AKI recognition, increased care, and shorter length of hospital stay in the intervention group but did not reduce 30-day AKI mortality [9].…”